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Category: Volume 05 Issue 08 August 2017
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Title: Aortic root abscess with complete heart block in a patient with acute lymphoblastic leukaemia

Authors: Dr Harish M M, Dr Ramya B M, Dr J.V.Divatia, Dr A.P.Kulkarni, Dr Amol T Kothekar

 DOI:  https://dx.doi.org/10.18535/jmscr/v5i8.63

Abstract

Infective endocarditis involving left side of the heart is more common than the right side. Aortic valve involvement is relatively less common than the mitral valve and is usually seen in the setting of underlying pathologies like bicuspid or quadricuspid valve, rheumatic heart disease and prosthetic valve. Conduction abnormalities occur in 45% of patients with aortic vegetation with perivalvular abscess with an underlying bicuspid or quadricuspid valve. Endocarditis and aortic valve root abscess in absence of such pathologies is a very rare occurrence. We report here a rare case of aortic valve root abscess without any underlying structural abnormality with complete heart block in an Immunocompromised patient.

Case Report: A 19 yr male patient with B - cell acute lymphoblastic leukemia (ALL) who had received induction chemotherapy, presented to casualty with history of fever, cough and breathing difficulty since 2days. The ECG showed premature ventricular escape beats. Subsequently ECG showed bradycardia and complete heart block leading to cardiac arrest. After successful resuscitation a transvenous pacemaker was inserted owing to persistent heart block. Artificial ventilation was continued. Persistent hypotension was treated by high dose adrenaline and vasopressin infusions. Transthoracic echocardiography showed aortic valve vegetations and perivalvular root abscess with moderate tosevere aortic regurgitation. Patient remained hypotensive despite vasopressors and eventually expired.

Conclusion: Though aortic valve endocarditis is usually seen in patients with underlying conditions like bicuspid aortic valve or rheumatic valvular heart disease it may rarely be seen in patients without any of such underlying conditions and should be considered during evaluation of any patient presenting with features consistent with aortic valve endocarditis especially in the Immunocompromised patients.

Keywords: Aortic root abscess, complete heart block, acute lymphoblastic leukemia, Immunocompromised patients.

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Corresponding Author

Dr Harish M M

Chief Consultant Intensivist, Department of Anaesthesiology, Critical Care Medicine and Pain

Tata Memorial Hospital, Tata Memorial Hospital, Parel, Mumbai-400012